Provider Demographics
NPI:1962694380
Name:WOOD, BRENDA M (PT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:1703 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-4273
Mailing Address - Country:US
Mailing Address - Phone:318-253-8846
Mailing Address - Fax:318-253-8875
Practice Address - Street 1:5435 HWY 1
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351
Practice Address - Country:US
Practice Address - Phone:318-253-8846
Practice Address - Fax:318-253-8875
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA00405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CX15Medicare PIN